A Case Report of Tarsal Navicular Body Fracture with Lateral Ankle Ligament Complex Tear – a New Injury Combination

Introduction: Fractures of tarsal navicular bone are a rare injury. A navicular fracture can occur either in isolation or associated with other bony or ligamentous injuries, depending on the severity and mechanism of trauma at the time of impact. We report a previously undescribed injury combination of navicular fracture with tear of the lateral ankle ligament complex. Case Report: An 18-year-old professional long jump athlete presented with a history of twisting injury immediately before taking off, while attempting a jump. A detailed clinical examination and radiological assessment with computed tomography (CT) and magnetic resonance imaging (MRI) scan were performed. She was diagnosed to have a navicular body fracture with complete rupture of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Acute fixation of navicular body fracture along with primary repair of ATFL and CFL was done. The final outcome of the patient was good with return to unrestricted physical activities after 4 months. Conclusion: A new injury combination of navicular fracture along with lateral ankle ligament complex tear is reported in a professional athlete. A high index of clinical suspicion and early detection using CT and MRI scan can identify this rare injury combination. Surgical treatment can result in favorable outcomes. Keywords: Tarsal navicular bone, fracture, anterior talofibular ligament, calcaneofibular ligament, computed tomography scan, magnetic resonance imaging scan.

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The Location of the Fibular Tunnel for Anatomically Accurate Reconstruction of the Lateral Ankle Ligament: A Cadaveric Study

BioMed Research International ◽

10.1155/2021/5575524 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Jeong-Hyun Park ◽

Hyung-Wook Kwon ◽

Digud Kim ◽

Kwang-Rak Park ◽

Mijeong Lee ◽

...

Keyword(s):

Double Bundle ◽

Single Bundle ◽

Anterior Talofibular Ligament ◽

Calcaneofibular Ligament ◽

Lateral Ankle ◽

Bony Landmarks ◽

Ankle Ligament ◽

Significant Difference ◽

Lateral Ankle Ligament ◽

Accurate Reconstruction

We aimed to describe the location of fibular footprint of each anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), as well as their common origin in relation to bony landmarks of the fibula in order to determine the location of the fibular tunnel. In 105 ankle specimens, the center of the footprints of the ATFL and CFL (cATFL and cCFL, respectively) and the intersection point of their origin (intATFL-CFL) were investigated, and the distances from selected bony landmarks (the articular tip (AT) and the inferior tip (IT) of the fibula) were measured. Forty-two (40%) specimens had single-bundle ATFL, and 63 (60%) had double-bundle patterns. The distance between intATFL-CFL and IT was 12.0 ± 2.5 mm , and a significant difference was observed between the two groups ( p = 0.001 ). Moreover, the ratio of the intATFL-CFL location based on the anterior fibular border for all cadavers was 0.386. The present study suggests a reference ratio that can help surgeons locate the fibular tunnel for a more anatomically accurate reconstruction of the lateral ankle ligament. Also, it may be necessary to make a difference in the location of the fibular tunnel according to the number of ATFL bundles during surgery.

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Immediate Unrestricted Weight Bearing with Simple Stirrup Brace Following Single Anchor Lateral Ankle Ligament Stabilization

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000040 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000 ◽

Cited By ~ 1

Author(s):

Christopher Diefenbach ◽

Linda Dunaway ◽

Larissa White ◽

Gregory Lundeen

Keyword(s):

Range Of Motion ◽

Ligament Reconstruction ◽

Weight Bearing ◽

Lateral Ligament ◽

Anterior Talofibular Ligament ◽

Recurrent Instability ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament

Category: Ankle Introduction/Purpose: Anatomic lateral ankle ligament reconstruction has been shown to reliably restore the functional stability of the joint. Current orthopedic literature supports accelerated rehabilitation and protected weight bearing advancement as a safe and effective means to timely patient recovery. To our knowledge, there have not been clinical outcome reports of a protocol utilizing immediate unrestricted weight bearing in a stirrup brace following single anchor lateral ligament stabilization. The purpose of this study is to report on a series of patients treated with a more progressive protocol resulting in durable ankle stability and favorable clinical outcomes. Methods: A total of 28 patients with chronic lateral ankle ligament instability who failed conservative management underwent arthroscopy and modified Brostrom-Gould lateral ligament reconstruction between 2014 and 2015 were identified. The anterior talofibular and calcaneofibular ligaments were released from the fibula and advanced using one double-loaded metallic 3.5 mm suture anchor. Immediate unrestricted full weightbearing in a stirrup brace was allowed from the first postoperative day and accelerated physical therapy was initiated at 2 weeks postoperatively. Patients were assessed preoperatively, and at a minimum 1- year follow-up, using the AOFAS Hindfoot scale and VAS pain score. Additional postoperative outcome measures included the FAOS and a custom clinical questionnaire. Range of motion, ligamentous stability and single-blinded examination with Star Excursion Balance Test (SEBT) functional testing were performed postoperatively. Complication and recurrent instability rates were also recorded. Results: Twelve patients participated in the study (8F, 4 M). Mean age at final follow-up was 49 years (21-70). Average follow-up was 21 months (16 to 26). Average satisfaction score was 94%, and all patients reported they would have the procedure again. AOFAS Hindfoot score and VAS improved significantly from preoperative to postoperative, respectively (55.6 to 89.8, 5.4 to 1.6). Average postoperative FAOS score was 80.3 (51.8-100) . No measurable difference was observed on examination of range of motion, ligamentous stability, or SEBT testing in the anterior, posterolateral or posteromedial planes of the contralateral side, respectively (61.5 to 62.2 cm, 62.4 to 64.1 cm, 56.4 to 57.6 cm). No patients reported recurrent instability. Conclusion: This study demonstrates that anterior talofibular ligament and calcaneofibular ligament advancement utilizing a single 3.5 mm anchor construct followed by immediate unrestricted weight bearing is a safe and effective protocol for the treatment of chronic lateral ankle instability. Ligamentous stability was achieved and maintained in all patients across a wide variety of patient ages and desired activity levels. Patient satisfaction was excellent. This surgical technique and postoperative protocol may help reduce surgical time and implant cost, and may facilitate a more timely return to preinjury functional level.

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Avulsion Fracture of the Lateral Ankle Ligament Complex in Severe Inversion Injury: Incidence and Clinical Outcome

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)79268-x ◽

2008 ◽

Vol 2008 ◽

pp. 161-162

Author(s):

B.F. Morrey

Keyword(s):

Clinical Outcome ◽

Avulsion Fracture ◽

Injury Incidence ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament ◽

Lateral Ankle Ligament Complex

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Lateral ankle ligament complex sprain – epidemiology in Varna region population

Scripta Scientifica Medica ◽

10.14748/ssm.v47i3.1215 ◽

2015 ◽

Vol 47 (3) ◽

pp. 39

Author(s):

Preslav Plamenov Penev

Keyword(s):

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament ◽

Lateral Ankle Ligament Complex

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A New Snowboard Injury Caused by “FLOW” Bindings

Journal of the American Podiatric Medical Association ◽

10.7547/0003-0538-104.3.287 ◽

2014 ◽

Vol 104 (3) ◽

pp. 287-290

Author(s):

Daniel Haverkamp ◽

Daniel Hoornenborg ◽

Mario Maas ◽

Gino Kerkhoffs

Keyword(s):

Surgical Repair ◽

Anterior Talofibular Ligament ◽

Syndesmotic Injury ◽

Lateral Ankle ◽

Ligament Rupture ◽

Ankle Ligament ◽

Lateral Ankle Ligament

We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate the cause and existence of medial and lateral ankle ligament rupture without osseous and syndesmotic involvement and to create awareness of these types of injuries.

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Epidemiology of Sprains of the Lateral Ankle Ligament Complex

Foot and Ankle Clinics ◽

10.1016/j.fcl.2006.07.002 ◽

2006 ◽

Vol 11 (3) ◽

pp. 659-662 ◽

Cited By ~ 189

Author(s):

Nicholas Antonio Ferran ◽

Nicola Maffulli

Keyword(s):

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament ◽

Lateral Ankle Ligament Complex

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Evaluation of the Anterior Talofibular Ligament Using MRI after Arthroscopic Lateral Ankle Ligament Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00447 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0044

Author(s):

Ichiro Yoshimura ◽

Kazuki Kanazawa ◽

So Minokawa ◽

Takuaki Yamamoto ◽

Tomonobu Hagio

Keyword(s):

Conservative Treatment ◽

Clinical Outcomes ◽

Signal Intensity ◽

High Signal Intensity ◽

High Signal ◽

Anterior Talofibular Ligament ◽

Ligament Repair ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament

Category: Ankle, Arthroscopy Introduction/Purpose: Ankle sprain commonly occurs in sports activities and most patients are successfully managed with conservative treatment. An incidence of 10–30% of patients will fail conservative treatment and result in chronic lateral ankle instability (CLAI) that may require surgical treatment. Recently, several systematic reviews reported that arthroscopic lateral ankle ligament repair for CLAI are provided good clinical results. However, the pathologic condition of the lateral ankle ligament after anatomical repair has not been clarified. Previous investigations have reported that ligament signal intensity using MRI has a strong negative linear relationship with material biomechanical strength properties. The purpose of this study was to report the clinical outcome and evaluation of the anterior talofibular ligament (ATFL) using MRI after arthroscopic lateral ankle ligament repair. Methods: We retrospectively reviewed 40 patients (40 ankles) who underwent arthroscopic lateral ankle ligament repair for CLAI. The average age at the time of surgery was 28 years (range 12–66 years). The average follow-up was 13 months (range 12– 18 months). Clinical outcomes were assessed preoperatively and 12 months postoperatively using Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and Self-Administered Foot Evaluation Questionnaire (SAFE-Q). The ATFL was evaluated using 3.0-T MRI at the preoperatively, six months postoperatively and 12 months postoperatively. The ATFL characteristics classified into the following categories: nonvisualization of the ligament, discontinuity, a wavy or curved contour, or high signal intensity within the ligament. Results: The mean JSSF score increased from 72 preoperatively to 95 at 12 months postoperatively. The preoperative MRI findings of the ATFL were categorized as discontinuity (11 ankles), a wavy or curved contour (14 ankles), or high signal intensity within the ligament (22 ankles). The all ATFL findings at the six months postoperatively had straight band extending from the talus to the fibular malleolus, and nine of 40 ankles had high signal intensity within the ligament. The ATFL findings at the 12 months postoperatively revealed residual high signal intensity within the ligament in six of nine ankles. A comparison of the postoperative ATFL with high signal intensity and with low signal intensity group, there were no significant difference in postoperative clinical outcomes between the groups. Conclusion: This study demonstrated that arthroscopic lateral ankle ligament repair was an effective procedure for the treatment of CLAI and restored the condition of ATFL.

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